Healthcare Provider Details

I. General information

NPI: 1750072385
Provider Name (Legal Business Name): MICHELLE MARTIN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 RAPHUNE HILL RD
ST THOMAS VI
00802-2905
US

IV. Provider business mailing address

7185 ESTATE TUTU
ST THOMAS VI
00802-1916
US

V. Phone/Fax

Practice location:
  • Phone: 340-690-5474
  • Fax:
Mailing address:
  • Phone: 340-998-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: